Factors Associated with the Prognosis after Operation in Children with Recurrent Intermittent Exotropia

BACKGROUND: To describe factors affecting the prognosis after operation for recurrent intermittent exotropia (X[T]) in children. METHODS: Clinical records of 50 patients who underwent operation for recurrent X(T) by a single surgeon were reviewed. The age at diagnosis of X(T), and first and second operations, deviation angle at distance and near, surgical method, concurrent vertical strabismus, stereoacuity, and Worth's Four Dot (W4D) examination before reoperation were analyzed, along with the postoperative deviation angle. A successful surgical outcome was defined as orthophoria, esodeviation ≤ 5 prism diopters, or exodeviation ≤ 10 prism diopters at distance. RESULTS: Among the 50 recurrent exotropes who underwent surgery and were followed up for more than 1 year postoperatively, 13 showed recurrent exotropia and 1 showed consecutive esotropia. The mean age at reoperation was 8.49 ± 2.19 years, and the mean duration of postoperative follow-up was 27.78 ± 12.02 months. Good near fusion before reoperation was a significant factor in the success of surgery (P = 0.006). Smaller postoperative deviation angle measured immediately and 2 months after surgery were related to smaller final deviation angle (P = 0.027 and P = 0.022, respectively). CONCLUSION: Peripheral suppression lowers the success rate of operation for recurrent X(T) in children. Overcorrection rather than orthotropia should be the target of immediate postoperative deviation angle. Peripheral suppression status and immediate and 2-month postoperative deviation angle may be important clues for predicting the final result of operation for recurrent X(T).

Development of Optic Disc Torsion in Children

PURPOSE: To document the development of disc torsion. METHODS: Consecutive disc photographs obtained at an interval of at least 1 year were reviewed retrospectively in 173 eyes of 173 Korean children. The angle of the vertical disc axis (AVDA) was measured in each fundus photograph with the fovea-disc center axis set at 0°. The associated change in the morphology of the optic disc was assessed by measuring the ratio of the horizontal to vertical disc diameters and the ratio of the maximum parapapillary atrophy width to vertical disc diameter. Eyes were divided into two groups with respect to the development of disc torsion: torsion and non-torsion group. Progressive torsion was defined as a change in AVDA between baseline and follow-up photographs beyond the coefficient of intraobserver repeatab ility. Factors associated with optic disc torsion were evaluated using logistic regression analysis. RESULTS: Mean subject age and refractive error at the time of baseline fundus examination were 6.8 ± 1.7 (range, 2 to 11) years and 0.2 ± 2.6 (range, −6.0 to +5.5) diopters, respectively. Mean follow-up period was 44.8 ± 21.1 (range, 12 to 103) months. Forty-two eyes (24%) were classified as torsion group who showed changes in AVDA that were greater than the intraobserver measurement variability (4.5°) during the follow-up period. The development of optic disc torsion was associated with greater myopic shift, a decrease in horizontal to vertical disc diameters, and an increase in parapapillary atrophy width to vertical disc diameter. CONCLUSIONS: Progressive optic disc torsion was a common phenomenon in the children included in this study. Torsion occurred as the result of optic disc tilt in an oblique axis in most cases. The findings provide a framework for understanding torsion-related glaucomatous optic nerve damage.

Clinical Results of Intacs(R) Ring Implantation in Keratoconus or Keratectasia

PURPOSE: To report the clinical results after the implantation of intrastromal corneal ring segments (Intacs(R)) for the correction of keratoconus or keratectasia. METHODS: This retrospective study was comprised of 16 eyes treated by insertion of intrastromal corneal ring and 30 eyes treated by penetrating keratoplasty (PKP) who were diagnosed with keratoconus or keratectasia. Visual acuity, refractive outcome, keratometric values were evaluated before and at 3 months, 6 months, and 12 months postoperatively. In addition, the implanted ring segment depth was measured by anterior segment optical coherence tomography and the results were compared based on the depth of the ring. RESULTS: Twelve months after treatment, best corrected visual acuity (BCVA) was log MAR 0.32 at the ring group and log MAR 0.20 at the PKP group. BCVA change was larger at the PKP group than the ring group. Postoperative keratometric value was smaller at the ring group than at the PKP group. 3 mm irregular astigmatism was larger at the ring group than at the PKP group. The shallowly implanted ring group had a larger effect than the deeply implanted ring group. CONCLUSIONS: Intrastromal corneal ring segment implantation appears to be effective in improving the visual acuity and refractive outcome, although it cannot substitute for PKP.

Methylene Blue for Localization of Sentinel Lymph Nodes in Breast Cancer: A Comparison with Isosulfan Blue / 한국유방암학회지

PURPOSE: Isosulfan blue dye has been widely used for localizing sentinel lymph nodes (SLNs) in breast cancer patients. The use of methylene blue has recently been applied for localizing SLNs. We compared the use of each dye to investigate the effectiveness of methylene blue for the localization of SLNs. METHODS: From January to December of 2005, 326 patients underwent surgery for breast cancer at Samsung Medical Center. In 86 patients, only a blue dye was used for SLN localization. Isosulfan blue and methylene blue were randomly given. Each dye (5 mL) was given by subareolar or peritumoral injection. The injection site was gently massaged with a warm gauze for 5 min. A frozen biopsy was performed for all SLNs, and an axillary dissection was done for positive frozen biopsy cases or cases in which axillary metastasis was clinically suspected. RESULTS: Fifty-eight cases (61.1%) had been treated with isosulfan blue and 37 cases (38.9%) had been treated with methylene blue. Blue nodes were found in 96.6% of samples in the isosulfan blue group and 86.5% of samples in the methylene blue group. The mean number of SLNs was 2.10 in the isosulfan blue group and 2.27 in the methylene blue group (p>0.05). The frozen biopsy was positive for malignant cells in 16 of 56 cases in the isosulfan blue group and 4 of 32 cases in the methylene blue group. Axillary lymph node dissection was performed in 23 cases in the isosulfan blue group and 19 cases in the methylene blue group. CONCLUSION: There are no significant differences in the success rate, the mean number of SLNs found and the false negative rate between the use of isosulfan blue and methylene blue for localization of SLNs in breast cancer patients.